#ECLS in adult critically ill pts, modes & mechanisms of benefit in different pathophysiological states: 🫁 respiratory: bridge to lung recovery + mitigating RV injury in in #ARDS, BTR in life-threatening airflow limitation, BT lung #transplantation + post-Tx recovery 🫀 cardiac #ECMO: bridge to myocardial recovery, bridge to heart or lung Tx + post-Tx recovery, #ECPR 🫀🫁 cardiorespiratory: bridge to lung + myocardial recovery in ARDS, BT LTx and post-Tx recovery 🩺 bridging mechanisms & clinical heterogeneity 🚧 limitations of ECLS Beyond simple gas exchange/circulatory support, ECLS stabilizes cardiorespiratory function and preserves end-organ perfusion serving as a bridge to recovery or definitive therapy. However, relative contribution of these mechanisms remains incompletely defined across clinical contexts and configurations. @ATSBlueEditor 🖇️ bit.ly/3Sk7D8m

Long-term outcomes after VA #ECMO in adults 🔍 multicenter @anzics study investigating incidence of death or new disability at 12 months after VA #ECLS initiation in 🇦🇺 & 🇳🇿 At 12 months 30% pts alive without new disability. Major burden of disability appears to develop in first 6 months ⚖️ different outcome associated with reason for ECLS ⚖️ at 12 months (vs 6) more pts independent in AdL (62.1% vs 48.2%), fewer unemployed due to health reasons (32.7% vs 47.4%) 🖇️ bit.ly/3Sxl5m0

Anticoagulation in #ECMO: how to reduce bleedings? 🔍prospective cohort study including 277 adults on #ECLS 🩸risk of hemorrhagic events 2.97-fold higher in patients with a PTT > 70 vs patients under no UFH therapy Association observed between target PTT & hemorrhagic complications, with risk higher when maintaining PTT values greater than 70". Lower PTT targets may reduce hemorrhages without increasing risk of thrombotic complications. @asaiojournal #FOAMcc #FOAMecmo 🔓 bit.ly/4hlO2vj

Veno-pulmonary #ECLS? carefully managed to avoid negative hemodynamic impact! 🩸elevated EBF increase mPAP/LAP & reduce PA pulsatility potentially leading to complications such pulmonary hemorrhage + permanent vasculature damage: hemodynamic response should be considered when selecting or titrating EBF 🫁🫀effect vary significantly depending on RV function. Consider RV injury severity & corresponding afterload, to maintain stability + prevent lung complications. @asaiojournal 🖇️ bit.ly/41VMnrP

Initiation of #ECPR in patients presenting with out-of-hospital cardiac arrest? Emergent mechanical circulatory support with VA #ECLS offers a bridge to diagnostic & therapeutic interventions, but can be challenging to provide in a timely fashion. 🔍 55 OHCA patients received ECPR after presenting to ED of large 🇺🇸 academic medical center with active #MCS + cardiac #transplantation program 🗓️ May 2013 to December 2022 🏥 increase in survival to hospital discharge from 22% to 52% 🧠 69% of those discharged had favourable neurologic function (CPC 1-2) Organizing & implementing a multidisciplinary dedicated #ECMO response team & ECPR program for OHCA, coordinating institutional resources, may improve survival + increase number of runs in OHCA patients. 🔗 bit.ly/4hhmirv

Right ventricular Injury in patients with in respiratory failure receiving VV #ECMO 🔍 scoping review aimed to map current literature & guide research on definition & management 📚 30 studies reported on RVI (dilation, dysfunction, failure) 📚 23 studies reported on (heterogeneous) definition, including #echocardiographic indices of RV function/dimensions 📚 13 studies reported on management, including VP & VA ECMO, positive inotropes, pulmonary vasodilators, ultra-lung-protective MV, PEEP optimization Despite high incidence & strong association with mortality, review highlights scarcity/heterogeneity in studies investigating modalities, criteria for diagnosis, therapeutic strategies for RVI during during VV #ECLS @asaiojournal 🔗 bit.ly/4fT9MxG 📚 Review informed Delphi study by PRORVnet study providing related expert position statements #FOAMcc on @yourICM 🔓 rdcu.be/dP6Kz

Development of novel VA #ECMO drainage cannula ⚙️ fluid dynamics #simulation 🔍 ex vivo evaluation 🩸hemolysis assay 🩸PLT activation & receptor shedding 🩸degradation of vW factor multimers 🩸clot volume analysis within cannulae @asaiojournal 🔗 bit.ly/4a4zpKJ

Use of extracorporeal blood purification therapies in #sepsis/septic shock 🧫 rationale & available clinical evidence supporting use of: #RRT, plasma exchange & coupled plasma filtration + adsorption, hemoadsorption 🩺 considerations for current clinical practice 🔍 (future) research: heterogeneity of populations & therapies dosing/timing, endpoints Integration of additional therapies within treatment protocols can optimize care/improve outcomes, but these must be applied at correct time/dose, taking into account their impact on drugs (eg ABTs). Era of “one size fits all” is over: time has come for paradigm shift toward more focused/personalized approaches in clinical practice/research. Open access #FOAMcc on @Crit_Care 🔓 rdcu.be/d422p

Permissive hypercapnia in acute severe respiratory failure: should we target PaCO2, pH or both?? Safe thresholds in critically ill? 🩺mechanisms & management of hypercapnia requiring IMV 🫁 impact of hypercapnia on outcomes 🫁 🫀🧠significant physiological effects: RV & pulmonary circulation, brain & other organs Hypercapnic acidemia during lung-protective MV may have significant consequences, and perhaps should not be a goal per se, but prompt early consideration of adjunctive therapies. Open access #FOAMcc 🔓 bit.ly/49TxOY8